ASK THE EXPERT - Life expectancy and treatment with anti-TNF therapy in RA patients

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Ask the Experts about New Therapies for Rheumatic Disease

From Medscape Rheumatology

November 2006

Life Expectancy and Treatment With Anti-TNF Therapy in RA Patients

Question

Are there any recent publications discussing life expectancy in

rheumatoid arthritis (RA)? Has this been affected at all by anti-tumor

necrosis factor (TNF) therapy, or is it too early to tell?

Henry Roth, MD

Response from Arthur Kavanaugh, MD

Arthur Kavanaugh, MD, Professor, Internal Medicine, University

of California at San Diego

One of the key aspects of the use of TNF inhibitors is their

overall risk/benefit ratio. While almost all clinicians are quite familiar

with the potentially very positive clinical responses achieved among

substantial numbers of treated patients, there remains concern about

toxicities, including potentially serious toxicities such as infection and

malignancy. Perhaps a very crude estimate of risk/benefit ratio would be

overall mortality. On the one hand, by effectively controlling systemic

inflammation, therapy with TNF inhibitors could be hypothesized to improve

mortality, as it has been established that patients with the most severe RA

have accelerated mortality. On the other hand, if serious adverse effects

were common, this could have a deleterious effect on overall mortality.

Several studies that have begun to address this seem to agree that overall,

treatment with TNF inhibitors has a beneficial effect on mortality. To date,

these studies have only been published in abstract form; hopefully the full

papers will be published soon.

Data from Fred Wolfe's National Data Bank analyzed 22,545 RA

patients from across the United States over 85,691 patient-years of

follow-up.[1] The 1713 deaths that occurred were assessed to determine

factors associated with this outcome. Of note, compared with patients not

receiving TNF inhibitors or methotrexate (MTX), the use of TNF inhibitors,

the use of MTX, and the use of TNF inhibitors plus MTX were all associated

with statistically significantly lower risks for death. From the South of

Sweden registry,[2] 1534 patients, 949 of whom were on TNF inhibitors, were

assessed for factors associated with mortality. Overall, patients on TNF

inhibitors had a slightly lower mortality rate that was not statistically

significant compared with those not on TNF inhibitors. However, when

adjusted for disease severity, using the Health Assessment Questionnaire

score, TNF-inhibitor treated patients had a significantly lower mortality.

Posted 11/06/2006

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References

1.. Michaud K, Wolfe F. Reduced mortality among RA

patients treated with anti-TNF therapy and methotrexate. Program and

abstracts of the American College of Rheumatology 2005 Annual Scientific

Meeting; November 13-17, 2005; San Diego, California. Abstract 296.

2.. sson LTH, Turesson C, Nilsson L, et al.

Treatment with TNF-blockers is associated with reduced premature mortality

in patients with rheumatoid arthritis. Program and abstracts of EULAR 2006:

7th Annual European Congress of Rheumatology; June 21-24, 2006; Amsterdam,

The Netherlands. Abstract SAT0186.

Disclosure: Arthur F. Kavanaugh, MD, has disclosed that he has

received grants for clinical research from Amgen, Abbott, Centocor,

Genentech, Bristol-Myers Squibb, and Biogen-IDEC.

http://www.medscape.com/viewarticle/546792

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